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Provider Prepared's Weekly Pearl of Wound Wisdom #25 To air or not to air?

Provider Prepared's Weekly Pearl of Wound Wisdom #25 To air or not to air? 0

After excellent closure of a scalp wound, those closed with staples or nonabsorbable sutures can be left open to air. After 24-48 hours, they should be gently cleansed with soap and water. 

Wounds that are small and superficial, requiring only a few staples or sutures for closure, can have suture or staple removal in 7-10 days. Larger more complex wounds should be considered for suture or staple removal after 10-14 days.

Hollander, JU et al. Assessment and management of scalp lacerations. UpToDate February 2018.

See Provider Prepared for the most affordable and honest way to be prepared for wound care at home and on the go!

Provider Prepared

Nathan Whittaker, MD

  • Brandon Durfee
Provider Prepared’s Weekly Pearl of Wound Wisdom #24 Gashing Galea!

Provider Prepared’s Weekly Pearl of Wound Wisdom #24 Gashing Galea! 0

A 32-year-old male presents to the emergency department with a laceration to the forehead extending up into the hairline. This occurred after a cut off wheel on a 7 inch grinder flew apart, and a portion of the cut off wheel impacted him in the head creating this laceration.

Assessment of scalp lacerations should also include assessment of all of the deep tissues. The galea is the connective tissue layer against the bone. This needs to be assessed to determine if there is presence of a galeal laceration. Lacerations of the galea larger than 0.5 cm should be repaired. Literature recommends using 3-0 or 4-0 absorbable suture material in the galea.

Repair of the galea helps prevent development of subgaleal infections, and subgaleal hematoma. Repairing galea lacerations also protects anchoring of the frontalis muscle, which has cosmetic implications.
Hollander, JU et al. Assessment and management of scalp lacerations. UpToDate February 2018.

This patient’s wound did involve the galea. A complex three layer repair was performed with excellent cosmetic outcome.

Visit here: Provider Prepared to see your options to be affordably and honestly prepared for all your wound care needs at home and on the go!

Provider Prepared
Nathan Whittaker, MD
  • Brandon Durfee
Provider Prepared’s Weekly Pearl of Wound Wisdom #23 Hook, line and sinker!

Provider Prepared’s Weekly Pearl of Wound Wisdom #23 Hook, line and sinker! 0

A 7 year old male is brought into the Emergency Department with a fish hook stuck in the bottom his left foot. He apparently stepped on the hook when it was accidentally left on the floor of his family’s home.

There are several techniques for fish hook removal. Among these are: the back out technique, the push through technique, needle technique, string technique. If these techniques fail then as a last resort the hook is cut out. Our preferred technique is the push-through technique, described as follows:

After anesthetizing the the area, using a hemostat the hook is advanced until the barb is exposed. Wire cutters are used to cut the barb off, wear eye protection while doing so. The reminder of the hook is then backed out of the wound. The resultant injury is then treated as a puncture wound.
Bothner, JO et al. Fish-hook removal techniques. UpToDate, November 2016.

This patient tolerated the push-through technique without any complications.

Provider Prepared’s laceration kits give you the capability and portability to remove fish hooks anytime anywhere.

Provider Prepared
Nathan Whittaker, MD

  • Brandon Durfee
Provider Prepared’s Weekly Pearl of Wound Wisdom #22

Provider Prepared’s Weekly Pearl of Wound Wisdom #22 0

A 30 year old male, who works as an auto mechanic, presents to the Emergency Department with a one week history of increasing pain, redness, and swelling to the ulnar nail edge of his right middle finger.

In general, an acute uncomplicated paronychia with abscess is treated with incision and drainage. After performing a digital block a number 11 blade is inserted under the affected cuticle margin, extending an incision along the lateral nail fold. Following incision and drainage, frequent warm soaks should be done to promote ongoing drainage.
Goldstein, BE et al. Paronychia. UpToDate December 2017.

Patients at risk for complicating infections should be placed on appropriate antibiotic treatment following incision and drainage.

Provider Prepared laceration kits with Lidocaine give you all the tools of the trade for management of paronychia at home!

Provider Prepared
Nathan Whittaker, MD


  • Brandon Durfee
Provider Prepared's Weekly Pearl of Wound Wisdom #21 Torn and Tearing

Provider Prepared's Weekly Pearl of Wound Wisdom #21 Torn and Tearing 0

A 93-year-old female presents to the emergency department for evaluation of wounds to her right forearm. She was working in her yard when she lost her balance and began to fall. As she put her arms out to catch herself, her right forearm scraped against nearby garden tools. She has several areas of torn skin upon the forearm. She otherwise did not receive other injuries.

As we age our skin becomes atrophic, has a decrease in elasticity, and develops impaired metabolic and reparative responses. The epidermis becomes thinner and there is flattening of the dermoepidermal junction. This results in a decrease in the skin’s ability to resist shear stress, increasing the fragility of the skin.
Taffet, GE et al. Normal aging, UpToDate January 2017.

Skin tears are appropriately managed with application of Steri-Strips to reapproximate the loosened epidermal and dermal tissues. After appropriate irrigation of the wounds, using Mastisol in conjunction with Steri-Strips the tissue can be secured into appropriate anatomical position. A loose nonadherent dressing should then be placed over the top of the Steri-Strip. Adherent dressings placed upon aged and torn skin will lead to additional skin tears, and therefore should be avoided.

All Provider Prepared Laceration Repair Kits are stocked with Steri-Strips and Stik-It (Mastisol equivalent) enabling you to appropriately and affordably manage skin tear wounds. Click HERE to order yours today!

Provider Prepared
Nathan Whittaker, MD
  • Brandon Durfee
Provider Prepared’s Weekly Pearl of Wound Wisdom #20 Getting on my nerves!

Provider Prepared’s Weekly Pearl of Wound Wisdom #20 Getting on my nerves! 0

A 23 year old male presents to the emergency department, with extensive laceration to his left forearm from a motorcycle accident. In addition to the pain of the laceration, he feels numb in his little finger, with tingling in his ring finger, and tingling in a part of the palm of his left hand.

Sensory and motor functions of the hand arise from innervation by the median, radius and ulnar nerves. Examination of the hand should always include checking motor function as well as pin prick, light touch and two-point discrimination. Normal two-point discrimination will increase with age and neuropathic disease, but is considered approximately 4-5 mm.
Bassett, RE et al. Finger and thumb anatomy. UpToDate, July 2016.

On examination of this patient’s left hand, he is found to have decreased sensation in the 5th digit, ulnar aspect of the 4th digit and weakness with extension of the digits and wrist. This raises the concern for injury to the ulnar nerve associated with the forearm laceration.

Visit Provider Prepared for honest, accurate and affordable wound care at home and on the go!

Provider Prepared
Nathan Whittaker, MD
  • Brandon Durfee